Millions of Americans live in counties without a general surgeon

More than 15 million Americans live in one of the 1,180 US counties with no general surgeon, and 951 counties have no surgeon in any of 12 surgical specialties, according to a new national analysis announced today at the ACS Clinical Congress 2026 in Washington, D.C., and simultaneously published today in the Journal of the American College of Surgeons (JACS).

The study and a companion interactive tool built on the same data, developed by the American College of Surgeons (ACS) and the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, map surgeons across 12 specialties and all 3,144 US counties from a single data source, allowing direct comparison for the first time. Previous studies examined one specialty at a time, used different data sources, or reported only national and state totals.

The ACS Surgical Workforce Mapping Tool visualizes the study's findings and gives patients, clinicians, and policymakers direct access to county-level data, allowing hospital boards, residency program directors, state legislators, congressional staffers, and patients to look up, compare, and download surgical workforce data for any county, referral region, or metropolitan/micropolitan area in the country.

For a patient, the question is not how many surgeons the country has; it is whether there is one available where they live. National averages can obscure substantial differences from one community to another. This study highlights a need to assess whether our national health workforce and reimbursement policies are supporting the ability of patients to access the right care at the right time and the right place."

Thomas C. Tsai, MD, MPH, FACS, Medical Director for Health Policy Research, ACS Division of Advocacy and Health Policy and co-author of the study

The analysis identified 201,394 surgeons practicing in the U.S. as of April 2025, or 59.2 surgeons per 100,000 people, and mapped each of them to the county, hospital referral region, and metropolitan/micropolitan area where they practice.

Study results

The 951 counties (30%) with no identified surgeon in any of the 12 specialties are home to 9.6 million people. The 1,180 counties (38%) with no general surgeon are home to 15.1 million.

Every one of the country's 306 hospital referral regions had at least one general surgeon, but these regions are large, multi-county areas defined by where patients travel for major surgical care, so the presence of a surgeon somewhere within one does not mean surgical care is close at hand for patients in its rural counties. Overall, surgeon supply across all 12 specialties was 12 times higher in some regions than others, from 20.8 surgeons per 100,000 people in Harlingen, Texas, to 250.4 in Rochester, Minnesota.

Access varied sharply by specialty. Transplant surgery, at 0.3 surgeons per 100,000 people, was absent from 179 of the country's 306 hospital referral regions, and the most specialized fields were consistently the smallest and the most geographically concentrated. Because the study classified all 12 specialties from a single data source using definitions the ACS developed with input from more than a dozen surgical societies, a community can see which specific specialties it lacks rather than a single aggregate surgeon count.

The findings also highlight potential challenges for rural communities. Researchers overlaid surgeon locations with federal facility files and found 475 hospitals and surgical facilities in counties with no identified full-time surgeon. Of those, 434 were critical access hospitals, the small rural facilities many communities depend on for emergency and inpatient care.

"The Surgical Workforce Mapping Tool gives policymakers, health systems, and communities a practical tool to understand their local surgical workforce and identify gaps in access to care," said Erin P. Fraher, PhD, MPP, Director of the Carolina Health Workforce Research Center at the UNC Sheps Center and the study's lead author.

Users can filter by specialty, switch between counties, hospital referral regions, and metropolitan/micropolitan areas, overlay hospitals and ambulatory surgical centers, and download maps for use in reports and presentations.

"Mapping the surgical workforce is the first step to crafting a thoughtful growth strategy," said Patricia L. Turner, MD, MBA, FACS, Executive Director and CEO of the American College of Surgeons. "These data will help guide investments in surgical training and support for surgeons in underserved communities, with the goal of improving patients' access to care."

The authors caution that uneven distribution is not automatically a problem to be corrected. Transplant surgery is concentrated in part because complex procedures are deliberately regionalized to preserve quality, and the most appropriate distribution is unlikely to be the same for every specialty.

Policy applications

The findings come as federal policymakers consider how to better identify communities with limited access to surgical care. The Ensuring Access to General Surgery Act of 2026 (H.R. 7198) would direct the Health Resources and Services Administration to develop a methodology for identifying general surgery shortage areas that considers surgeon supply and geographic service areas.

The mapping tool could help policymakers and health care leaders identify where workforce interventions may have the greatest impact, including investments in graduate medical education, rural surgical training, and programs designed to attract and retain surgeons in underserved communities.

About the data

The study and interactive tool use surgeon location data from the April 2025 National Plan and Provider Enumeration System, a federal registry of clinicians with National Provider Identifiers. Facility locations were drawn from Centers for Medicare & Medicaid Services Provider of Services files.

The analysis identifies where surgeons are located but does not measure patient travel time, surgical volume or capacity, or whether individual surgeons practice at specific hospitals. Full methodology, data sources, and study limitations are available in the JACS study.

Access The ACS Surgical Workforce Mapping Tool

The ACS Surgical Workforce Mapping Tool is free and publicly available on the ACS website. Full methodology and data source documentation are available on facs.org. The study is published as an article in press on the JACS website.